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Before the early 1970s the treatment of urinary incontinence owing to intrinsic sphincteric deficiency, particularly in men with this problem after prostatectomy, posed a nearly insurmountable challenge. Operations using the patient’s own tissues as well as bulbous urethral sling-type procedures with various types of prosthetic materials produced inconsistent and nondurable results [1–4]. The artificial urinary sphincter was introduced in 1973 [5]. In the first 10 yr after its introduction the basic device design changed four times. The fifth generation model, the AMS Sphincter 800 (American Medical Systems, Minnetonka, MN), was introduced in 1983 [6]. To decrease mechanical failure numerous changes have been made to the various components of this device; however, its basic design and mode of operation have remained unchanged for >20 yr. The AMS Sphincter 800 consists of three components: a urethral cuff, a scrotal pump-control assembly, and a single pressure-regulating balloon (PRB), which is usually implanted in the retropubic space. These three components are implanted individually and then connected by two tubing connectors. The control assembly, which is above the pump, has valves controlling the direction of flow, a delayed filled resistor, and a deactivation button. After the device is implanted, the pump is

Postprostatectomy urinary incontinence is a disorder that often has a devastating effect on quality of life for those who suffer from it. The artificial urinary sphincter (AUS) has become the gold standard for the treatment of this disorder, but this prosthetic device is expensive, requires manual manipulation, and is associated with mechanical failure. Slings to treat postprostatectomy urinary incontinence are not new; they date back to at least 1951 [1]. The failures of these early sling operations as well as other procedures for treatment of postprostatectomy urinary incontinence led in part to the development of the AUS [2]. Despite the success of the AUS, there has been a renewed interest in

When the outcome of penile prosthesis implantation according to the surgeon is excellent and the patient is displeased, the reason in my experience is almost always that the patient’s expectations in terms of penile size have not been met. With today’s three-piece inflatable penile prostheses, penile girth is seldom an issue. Instead when prosthesis recipients are dissatisfied, it is usually because their expectations in terms of length with the prosthetic erection have not been met. This is based on the patient’s recall of his erect penile length. Many of these men with erectile dysfunction have not had a normal erection in many months or years. Some have become obese with added adipose tissue in the prepubic area. Others have acquired disorders (e.g., Peyronie’s disease) that produce penile shortening. Even in the absence of these factors, a patient’s recall of his former erections may sometimes err in the direction of exaggerated length. In this issue, Deveci and coworkers compare stretched penile length to penile length following three-piece or two-piece inflatable penile prosthesis implantation in 56 first- time penile prosthesis recipients [1]. Although they found no found no statistically significant difference in stretched penile length before implant surgery and penile length with the prosthesis after surgery, 72% of the recipients reported a decrease in their penile length after surgery. Perceived loss of penile length was more common in men who had undergone radical prostatectomy. Savoie et al. measured stretched penile length before and after radical prostatectomy in 124 men [2]. There was a significant decrease in stretched penile length after prostatectomy and in 12 patients (19%) it was a 15% decrease. The findings of Deveci et al. in this regard therefore are